MRI弥散加权成像对原发性硬化性胆管炎患者肝纤维化评估价值分析

doi:10.3969/j.issn.1672-5069.2021.03.018

摘要/Abstract

摘要： 目的探讨应用动态增强磁共振成像(DCE-MRI)和弥散加权成像(DWI)诊断原发性硬化性胆管炎(PSC)患者显著性肝纤维化的价值。方法 2010年8月～2020年12月我院诊断的PSC患者68例,行肝活检检查,采用METAVIR分期评分系统评价肝纤维化分期,行MR检查获得肝细胞摄取率(Ki)、肝细胞外容积(Ve)、门静脉流量(Fv)和肝动脉流量(Fa),计算肝总血流量(Ft)、细胞外平均通过时间(MTT)和肝脏摄取分数(Fi),测量表观弥散系数(ADC)。应用多因素Logistic回归分析影响肝纤维化程度的因素,应用受试者工作特征曲线(ROC)下面积(AUC)分析MRI定量参数评价肝纤维化的效能。结果在68例PSC患者中,肝组织学检查发现非显著性肝纤维化(F0/F1期)24例,显著性(F2/F3/F4期)肝纤维化44例;两组血清ALT、AST、ALP、GGT、TBIL、INR、IgG及Ki、Fi和ADC等差异具有统计学意义(P<0.05);多因素Logistic回归分析发现ALT、AST、ALP、GGT、INR、IgG、Ki和ADC是影响肝纤维化的独立预测因素(P<0.05);经ROC分析,以Ki=3.5/100 min为截断点,其诊断PSC患者显著性肝纤维化的敏感度为70.5%和特异度为58.3%;以ADC为1.14 s/mm²为截断点,其诊断PSC患者显著性肝纤维化的敏感度为90.9%和特异度为83.3%。结论应用DWI指标诊断PSC患者肝纤维化有一定的临床应用价值,值得进一步研究。

关键词: 原发性硬化性胆管炎, 动态增强磁共振成像, 弥散加权成像, 表观弥散系数, 诊断

Abstract: Objective The aims of this study was to explore the diagnostic efficacy of significant liver fibrosis by apparent diffusion coefficient (ADC) in patients with primary sclerosing cholangitis (PSC).Methods A total of 68 patients with PSC were included in this study in our hospital between August 2010 and December 2020, and all patients underwent liver biopsies and MR scan. The liver fibrosis was estimated by METAVIR staging scoring system, and the hepatocellular uptake rate (Ki), extracellular volume (Ve), portal venous flow (Fv) and arterial flow (Fa) were obtained from MRI, calculating the total blood flow (Ft), extracellular mean transit time (MTT) and hepatic uptake fraction (Fi). The apparent diffusion coefficient (ADC) was also determined. The univariate and multivariate Logistic regression analysis was applied to reveal the impacting factors of liver fibrosis in PSC patients. The area under the receiver operating characteristic curve (AUROC) was applied to analyze the diagnostic efficacy of each parameter.Results Out the 68 patients with PSC, the liver histopathological examination showed that non-significant liver fibrosis staging F0/F1 was in 24 cases, and significant liver fibrosis staging F2/F3/F4 was in 44 cases; there were significant differences as respect to serum ALT, AST, ALP, GGT, bilirubin, INR, IgG as well as Ki, Fi and ADC (P<0.05); the multivariate Logistic regression analysis demonstrated that serum ALT, AST, ALP, GGT, INR, IgG, and Ki and ADC were the independent impacting factors for liver fibrosis (P<0.05); the ROC analysis showed that the sensitivity and specificity by Ki in diagnosing significant liver fibrosis were 70.5% and 58.3% when the Ki=3.5/100 min was set as the cut-off-value, and those by ADC were 90.9% and 83.3% when it equal to 1.14 s/mm² as the cut-off-value.Conclusion The application of ADC in predicting liver fibrosis in patients with PSC is promising, and warrants further investigation.

Key words: Primary sclerosing cholangitis, Dynamic contrast-enhanced magnetic resonance imaging, Diffusion-weighted imaging, Apparent diffusion coefficient, Diagnostic trial

刘彦荣, 王苗, 曾果, 许晓亮. MRI弥散加权成像对原发性硬化性胆管炎患者肝纤维化评估价值分析[J]. 实用肝脏病杂志, 2021, 24(3): 375-378.

Liu Yanrong, Wang Miao, Zeng Guo, et al. Diagnostic efficacy of significant liver fibrosis by apparent diffusion coefficient in patients with primary sclerosing cholangitis[J]. Journal of Practical Hepatology, 2021, 24(3): 375-378.

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